Adjournment Debate. - Coronary Artery By-Pass Surgery.

I thank the Ceann Comhairle for allowing me to raise on the Adjournment the extraordinary loose, unChristian and uninformed remarks made by the Minister for Health in the Dáil Chamber on 26 March 1992.

The Minister has a reputation for sometimes talking before he thinks, an unfortunate practice for one in charge of an area as sensitive as the health services. To say that artery by-pass operations have become very fashionable, that a person's life cannot be lengthened by an operation any more than it can be lengthened by taking tablets prescribed for the condition, that he would defy any consultant cardiologist to contradict what he was saying and that an operation may improve the quality of life but the same results can be achieved with tablets, defies the imagination. He also said it was an acceptable fact that hi-tech ultramodern medicine gobbles up huge financial resources of the health budget and these resources may be better utilised in the primary care area of medicine, education or the environmental needs of the country.

I take no pleasure in castigating or contradicting a fellow medical practitioner. I take no pleasure at all in questioning the veracity of the Minister's statements. There are five effective methods for the treatment of coronary artery disease which has progressed to the stage where it causes symptoms. These are as follows: (1) the adoption of a healthy lifestyle; (2) the treatment of pre-disposed conditions, such as high blood pressure or high blood fats; (3) drug treatment; (4) angioplasty and (5) coronary artery by-pass graft, or CABGs, as the Minister referred to them. The first two procedures are employed on all patients for whom they are relevant. Drug treatment is used by every family doctor. The vast majority of patients referred to cardiologists have already been on drug treatment which has failed to relieve their symptoms. It is because of this failure that these unfortunate patients are referred to cardiologists and cardiac surgeons for assessment.

Coronary artery surgery was introduced in Ireland in 1967. The indications for this procedure are well recognised and documented. Assessment will discover whether a patient has extensive coronary artery disease which, if not corrected, may lead to the person suffering a heart attack or, even worse, dying suddenly. Angioplasty dilates the arteries with a balloon and does not require an operation. In cases where it is deemed to be a safe and potentially effective alternative it is used as the intervention of first choice.

Coronary artery surgery candidates fall into clearly defined groups: the unfortunate patient with angina at rest; the pre-coronary syndrome patient; the post-coronary patient with blocked arteries and, most dramatic of all, the patient who is discovered to have his left anterior descending coronary artery seriously blocked — the so-called widow-maker — who will almost certainly die suddenly if he does not have this operation. That is a well documented medical fact.

I wish to point out to the Minister that the anguish, pain, worry and mental torture he has caused to patients who have had the operation, patients who have had a stormy recovery period after an operation, the families of patients who tragically have not recovered from the operation and people on the waiting list for the operation is incalculable. It is unbecoming for a person in the Minister's position to make the kind of unfounded statements he made in regard to the operation. When taken in the context of the Minister's previous gaffe when he suggested that consultants should contribute £5 million of their back pay award to the mentally handicapped services, forgetting that the Government will take in £7 million in income tax, his statement defies imagination. To say that this operation is fashionable is not only damaging to patients who have undergone or who are awaiting surgery but casts a slur on the integrity, ethics and professional competence of cardiac surgeons, cardiologists and anaesthologists.

I am glad I paid little attention to what the Deputy had to say. However, I am happy he has raised this matter as it gives me the opportunity to clarify what I said regarding cardiac surgery. I should like the Deputy to read again what I said in regard to that matter.

First, I did not question cardiac surgery procedures where there is a clearly established need for this form of treatment. There are high quality cardiac surgery units in Ireland. There is no question about that. I called in the four cardiac surgeons and asked them if they would consider increasing the number of cardiac operations for this condition. I provided the necessary funds and the number of cardiac operations is being increased.

I wish to refer to the general question of the appropriateness of certain types of treatment for patients who suffer from various illnesses. Patients must be given options when faced with a diagnosis of heart disease. I should like all patients to have the options for treatment set out so that they can be involved in the decision-making process which must follow the diagnosis. It is my intention to cover this matter in the patient's charter which I am presently preparing.

As the Deputy may know, there are patients who have coronary heart disease of a level which would not justify surgery. The management in regard to heart disease can be divided into four main elements. These are, first, prevention which involves changing one's lifestyle — giving up smoking, taking measures to lower blood cholesterol and blood pressure levels. These measures are vital. Then there is medical treatment, angioplasty and coronory artery by-pass graft. But as I have often said, the best course of all is prevention. Some of the problems can be solved by us as a community; the answer is in our hands. As I said today to the Irish Heart Foundation, we must modify our lifestyles to protect and promote health.

Medical treatment has certainly conributed not only to a decline in mortality but has improved the quality of life of many patients. The majority of patients with heart disease can be treated in this way. Angioplasty is a new technique which can be of considerable benefit to a certain proportion of patients with single artery disease. There are considerable merits in the technique as it can be performed under local anaesthetic and the patient can often be mobile after 24 hours and discharged after 48 hours. Symptoms can be reduced and good clinical results can be expected in the case of the vast majority of patients who undergo this procedure. This procedure is now being performed by Harefield Hospital on patients with diseases other than single artery disease.

Coronary artery by-pass graft is an extremely successful procedure: I have never doubted that. However, coronary artery studies show that medical treatment is almost as effective as the by-pass graft, as the survival rates after five years are almost the same. I merely expressed my concern that the procedure should only be undertaken where appropriate, in cases which do not respond to medical treatment.

It is generally agreed that in some countries patients may have inappropriate cardiac surgery and two cardiologists in Dublin — in two articles inModern Medicine in 1990 — said that we must ensure this will not happen here. The Deputy should read the articles in which this was stated.

I already told the House that I am fully in favour of a second post of cardiac surgeon in Cork. We hope to have a surgeon in practice before the end of this year. On 26 March 1992 I announced in the House the allocation of special funding of £120,000 to enable an additional 40 open-heart operations to be carried out in the Mater Hospital this year as an immediate step to reduce the numbers on the waiting list.

I have also indicated that it is my intention to provide additional cardiac surgery capacity in Dublin and I will be making decisions in this area at the earliest possible date. I question the relevance of the Deputy's statement about mental handicap.

It was the Minister's statement, not mine.

If we can get the money from the consultants, well and good. I threw it in as an afterthought but they did not respond. However, it is not relevant to this issue and should not be confused with it. There is nothing wrong with asking the consultants if they would like to contribute.